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NFL gains yards in its treatment of players’ head injuries

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As early as this season’s playoffs, National Football League players will have to get the approval of an independent neurosurgeon or neurologist before they can return to play following a head injury or concussion. Currently, each team’s general physician gives the "okay" for players to get back in the game, sometimes, experts fear, when athletes have not fully recovered.

NFL Commissioner Roger Goodell described this shift and other changes in how the league will handle head injuries, such as continuing research to help improve equipment safety, in a statement released on November 24 by the NFL. The decision to work with external neurosurgeons is meant to give players the best medical advice, Goodell said in a November 23 interview on NBC’s "Football Night in America." "This is a chance for us to expand [the advice] and bring more people into the circle to make sure we’re making the best decisions for our players in the long term," he added.

The decision comes in the wake of mounting evidence that head injuries lead to long-term effects such as brain damage and dementia. One survey commissioned by the NFL recently concluded that there was greater incidence of cognitive damage among retired players than in the national population, but some NFL officials dismissed the findings. At a congressional hearing in October on the issue of football and brain injuries, Rep. Linda Sanchez said that the league’s denial of long-term effects of head injuries was reminiscent of tobacco companies denying a link between smoking and disease, the Associated Press reported Wednesday.

Dr. Thom Mayer, medical director of the NFL Players Association, says he instigated the policy change, adding: "It was a growing sense that we needed a clearer cut mandate independent of the league" to determine when players could return to play.

Mayer pointed out that, currently, each of the league’s 32 teams has a physician who, depending on their background, may or may not be trained in concussion management. Only the Pittsburgh Steelers and the Indianapolis Colts employ a team neurosurgeon.

But even for teams that have concussion experts onboard, critics say there could be pressure from the coaching staff to unduly speed the return of injured players to the game.

The new policy will improve players’ medical care in two ways: "One is that we wanted expertise, and two is a voice that is independent of the team itself," Mayer says.

Mayer and Dr. Elliot Pellman, medical advisor for the NFL, are in the process of appointing the independent neurosurgeons and neurologists, which should be completed within the next few weeks. At each game, the home team’s appointed expert will provide care for head injuries. Moreover, the neurosurgeon’s or neurologist’s recommendation will be mandated, Mayer says. A player will not be able to return to the game until he passes a cognitive test and has approval from this specialist.

It is unclear how these physicians will be paid for their work.

The changes will make the NFL’s treatment of head injuries more similar to that of the National Hockey League. Both teams have been doing baseline cognitive tests of each player prior to the start of each season. Since 1997 the NHL has also had independent neuropsychologists perform these tests on players after they recovered from a head injury and before they could return to play. But, unlike the NFL’s proposed plan, these neuropsychologists do not actually make an argument for or against return-to-play. Instead, the NHL teams’ physicians consider the test results in making the decision.

Mayer hopes the attention brought to head injuries in the NFL could help encourage players to report head injuries and their effects to the team’s medical staff. Pride and a sense of obligation to their team, he says, drive players to hide injuries. Mayer, along with current and retired players, is starting a committee that will meet for the first time in January to talk with other players and their families about the threat of head injuries.

Image courtesy of flickr/courteney

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  1. 1. Guillermo57 7:57 pm 11/27/2009

    This is a welcome development and the NFL is to be commended for taking this action, but there is an even larger problem with the high school and college level sports that do not have these resources to bring to bear. We need to figure out what to do to protect these young amatuer athletes from life altering injurys!

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  2. 2. Guillermo57 8:01 pm 11/27/2009

    This is a welcome development and the NFL is to be commended, but there is an even larger problem with the number of high school and college athletes that are at risk from the same type of disabling injuries, and where the resources are not available to protect them. We need to address this problem also!

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  3. 3. integral 10:43 am 11/30/2009

    It has become clear, via research cited in the recent New Yorker magazine, that playing tackle style football is even more dangerous to a young man’s head than boxing. At least a boxer, if skilled, can protect his skull by fending off blows. In football you are expected to use your head as a battering ram and most of the damage is done during daily practice, as players at North Carolina, wearing helmets equipped with wireless monitors clearly show. Better and better safety helmets are good at preventing cracked skulls, but ineffective at preventing brain tissue from violently slamming into the hard skull.
    It appears to me that we are at the beginning of a (probably) long, slow movement to drop school football programs. In the future, we may regard pro football players as we now regard boxers, with a mixture of sadness and pity.

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  4. 4. thermopraxis 3:29 pm 05/18/2012

    There is something that can be done now and your help is needed to spread the word about it. Thermopraxis has created a revolutionary in-helmet device that can be used to drastically reduce the devastating consequences of concussions using therapeutic hypothermia (cooling). The sooner this product reaches the market, the sooner these types of injuries can be reduced in helmet-wearing athletes. For more information, please see the Concussion Crisis Solution Campaign on YouTube and

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